The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies.

Autor: Chlorogiannis DD; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA., Sotirchos VS; Weill-Cornell Medical College, Interventional Oncology/Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA., Georgiades C; Department of Vascular and Interventional Radiology, Johns Hopkins University, Baltimore, MD 21287, USA., Filippiadis D; 2nd Department of Radiology, University General Hospital 'Attikon', Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece., Arellano RS; Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA., Gonen M; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA., Makris GC; Department of Vascular and Interventional Radiology, Guy's and St Thomas Hospital, NHS Foundation Trust, London SE1 9RT, UK., Garg T; Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA., Sofocleous CT; Weill-Cornell Medical College, Interventional Oncology/Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Dec 12; Vol. 15 (24). Date of Electronic Publication: 2023 Dec 12.
DOI: 10.3390/cancers15245806
Abstrakt: Background: Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic review and meta-analysis aimed to encapsulate the current clinical evidence concerning the optimal TA margin for local cure in patients with colorectal liver metastases (CLM).
Methods: MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception until 1 May 2023, in accordance with the PRISMA Guidelines. Measure of effect included the risk ratio (RR) with 95% confidence interval (CI) using the random-effects model.
Results: Overall, 21 studies were included, comprising 2005 participants and 2873 ablated CLMs. TA with margins less than 5 mm were associated with a 3.6 times higher risk for LTP (n = 21 studies, RR: 3.60; 95% CI: 2.58-5.03; p -value < 0.001). When margins less than 5 mm were additionally confirmed by using 3D software, a 5.1 times higher risk for LTP (n = 4 studies, RR: 5.10; 95% CI: 1.45-17.90; p -value < 0.001) was recorded. Moreover, a thermal ablation margin of less than 10 mm but over 5 mm remained significantly associated with 3.64 times higher risk for LTP vs. minimal margin larger than 10 mm (n = 7 studies, RR: 3.64; 95% CI: 1.31-10.10; p -value < 0.001).
Conclusions: This meta-analysis solidifies that a minimal ablation margin over 5 mm is the minimum critical endpoint required, whereas a minimal margin of at least 10 mm yields optimal local tumor control after TA of CLMs.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje